It's got to be about enjoying yourself: young people, sexual pleasure,and sex and relationships education

Pleasure as a component of sexualities and relationships education (SRE) has been subject to much recent discussion. Arguably, academic debate has been more prominent than practitioner perspectives, with theoretical articulations and critique superseding pragmatic attention to integrating pleasure into learning about sexualities and relationships. Though there are exceptions, sexuality education that recognises pleasure and desire for young people remains absent in many contexts, despite calls for its inclusion for more than two decades. This paper offers a synthesis of expert opinion to outline the importance of pleasure and positive SRE to sexual health, rights, equality and safeguarding against coercion and harm. The paper acknowledges the often uneasy associations between sexuality, education and youth by identifying key political and academic debates, before offering a rationale on ways forward that may help persuade curriculum gatekeepers of its merits. Analysis focuses mainly on young women with reflections on current knowledge and the need for more empirically based research and theorising on boys and men. Policy developments relate to the UK, though issues raised have direct relevance for contexts where SRE is similarly contested. Keywords: sex education; gender equality; pleasure; sexual health; young people; U

Evaluation of Sexual Health Sheffield's services in community settings : perspectives from young people aged 15-25 years.

This report details findings from an evaluation of Sexual Health Sheffield’s (SHS) services in community settings (also known as Community Engagement Services) from the perspective of young people aged 15-25 years. The evaluation was carried out during September 2014 to January 2015. Twenty nine young people aged 15-25 years who live in Sheffield or have used Sexual Health Sheffield’s services participated in the evaluation via interviews and focus groups. Experiences and utility of the services were contextualised in relation to geographic locality, social class, genders, sexualities, education/schooling and home/family circumstances. Community engagement services were widely regarded as excellent, with clear pointers to areas for further development in community and clinical settings. These include, more routine acknowledgement of the links between mental and sexual health, continued availability of free condoms, bolder promotion of services, and the recognition of sexuality and gender identities beyond binary categories. Sex and relationships education in school was reported as poor or non-existent, and community engagement services provided the only sources of education for a majority of participants

Developing sexual competence? Exploring strategies for the provision of effective sexualities and relationships education

School-based sexualities and relationships education (SRE) offers one of the most promising means of improving young people's sexual health through developing 'sexual competence'. In the absence of evidence on whether the term holds the same meanings for young people and adults (e.g. teachers, researchers, policy-makers), the paper explores 'adult' notions of sexual competence as construed in research data and alluded to in UK Government guidance on SRE, then draws on empirical research with young people on factors that affect the contexts, motivations and outcomes of sexual encounters, and therefore have implications for sexual competence. These data from young people also challenge more traditional approaches to sexualities education in highlighting disjunctions between the content of school-based input and their reported sexual experience. The paper concludes by considering the implications of these insights for developing a shared notion of what SRE is trying to achieve and suggestions for recognition in the content and approaches to SRE.</p

Clarity, conviction and coherence supports buy-in to positive youth sexual health services: focused results from a realist evaluation

Background: There is a call for sexual health services to support young people achieve sexual wellbeing in addition to treating or preventing sexual ill-health. Progress towards realising this ambition is limited. This study aimed to contribute theory and evidence explaining key processes to support local delivery of positive youth sexual health services. Methods: A realist evaluation was conducted, comprising four research cycles, with a total of 161 data sources, primarily from the UK. Theory was refined iteratively using existing substantive theories, secondary and primary research data (including interviews, documentary analysis, feedback workshops and a literature search of secondary case studies). A novel explanatory framework for articulating the theories was utilised. Results: The results focused on local level buy-in to positive services. Positive services were initiated when influential teams had clarity that positive services should acknowledge youth sexuality, support young people's holistic sexual wellbeing and involve users in design and delivery of services, and conviction that this was the best or right way to proceed. How positive services were operationalised differed according to whether the emphasis was placed on meeting service objectives or supporting young people to flourish. Teams were able to effect change in local services by improving coherence between a positive approach and existing processes and practices. For example, that a) users were involved in decision making, b) multi-disciplinary professional working was genuinely integrated, and c) evidence of positive services' impact was gathered from a breadth of sources. New services were fragile. Progress was frequently stymied due to a lack of shared understanding and limited compatibility between characteristics of a positive approach and the wider cultural and structural systems including medical hegemony and narrow accountability frameworks. These challenges were exacerbated by funding cuts. Conclusions: This study offers clarity on how positive youth sexual health services may be defined. It also articulates theory explaining how dissonance, at various levels, between positive models of sexual health service delivery and established cultural and structural systems may restrict their successful inception. Future policy and practice initiatives should be theoretically informed and address barriers at societal, organisational and interpersonal levels to stimulate change

Provision of positive sexual health services for young people: a realist evaluation

Background English and international policy calls for positive, comprehensive youth sexual health services (PCYSHS) that support young people to achieve sexual wellbeing. In practice, youth sexual health services are often oriented solely towards reducing unwanted conceptions and preventing sexually transmitted infections. This study aimed to develop theory and recommendations for practitioners to support delivery of PCYSHS. Methods A realist evaluation was undertaken to uncover what works, for whom, and under what conditions, to deliver PCYSHS. We developed concepts and initial theories, in which we combined existing substantive theory with a logic model based on stakeholder's tacit knowledge, observational visits, and data that were relevant to underlying causal processes, extracted from academic and policy literature (27 sources). Academic sources were identified via a systematic search of four electronic databases. Search terms were “sexual health”, combined with “sex positive”, “young people”, “service”, and synonyms (“reproductive health”, “sexual subjectivity”, “sexual rights”, “holistic”, “integrated”, “reproductive rights”, “preventative”, “comprehensive”, “young”, “youth” “teen*”, “adolescen*”, “intervention*”, “framework*”, “paradigm*”, “programme*”, “model*”, “trial*”, “pilot*”) with no date restrictions. We selected papers relating to whole system transformation to PCYSHS in developed countries, written in English. Papers that considered only education settings, one-off interventions, or information resources were excluded. Papers were appraised by rigour and relevance in accordance with realist methodology guidelines. Evidence was then gathered from case studies of three services in England that had attempted implementation of PCYSHS. Data were derived via stakeholder interviews (n=24), social and print media (15), service specifications (5), and evaluation and consultation documentation (5). Analysis of these data (Nvivo, version 10) was directed at substantiating, refining, or refuting the initial theories. Ethics approval was given by Sheffield Hallam University Research Ethics Committee. Findings 76 sources contributed to the development and testing of programme theories. The theories articulated how local buy-in to PCYSHS could be led by the following factors: clarity of both the concept and individual role; conviction in the approach to bring about positive change for young people; and coherence with local and national priorities. The theories suggested the mechanisms by which these factors work and showed the ways in which outcomes are contextually dependent. Interpretation This study explains some of the challenges of translating the policy ambition of PCYSHS into practice. The realist inquiry found theoretical mechanisms that might affect delivery of PCYSHS and the contextual conditions that could hinder or enable them. These theories can help inform the development and evaluation of PCYSHS initiatives

The pleasure imperative? Reflecting on sexual pleasure’s inclusion in sex education and sexual health

This article offers an empirically grounded contribution to scholarship exploring the ways in which pleasure is ‘put to work’ in sex and sexuality education. Such research has cautioned against framing pleasure as a normative requirement of sexual activity and hence reproducing a ‘pleasure imperative’. This paper draws on interviews with sexual health and education practitioners who engaged with Pleasure Project resources and training between 2007 and 2016. Findings suggest that practitioners tend to understand pleasure within critical frameworks that allow them to avoid normalising and (re)enforcing a pleasure imperative. Accounts also show negotiations with, and strategic deployments of, values surrounding sexual pleasure in society and culture. While some accounts suggest that a pleasure imperative does run the risk of being reproduced by practitioners, notably this is when discussing more ‘contentious’ sexual practices. Interviews also demonstrate that practitioners attempting to implement a pleasure agenda are faced with a range of challenges. While some positive, holistic, and inclusive practice has been afforded by a pleasure approach, we argue that the importance of a critical framework needs to be (re)emphasised. The paper concludes by highlighting areas for further empirical research

'Selling it as a holistic health provision and not just about condoms ?' Sexual health services in school settings: current models and their relationship with sex and relationships education policy and provision

In this article we discuss the findings from a recent study of UK policy and practice in relation to sexual health services for young people, based in - or closely linked with - schools. This study formed part of a larger project, completed in 2009, which also included a systematic review of international research. The findings discussed in this paper are based on analyses of interviews with 51 service managers and questionnaire returns from 205 school nurses. Four themes are discussed. First, we found three main service permutations, in a context of very diverse and uneven implementation. Second, we identified factors within the school context that shaped and often constrained service provision; some of these also have implications for sex and relationships education (SRE). Third, we found contrasting approaches to the relationship between SRE input and sexual health provision. Fourth, we identified some specific barriers that need to be addressed in order to develop 'young people friendly' services in the school context. The relative autonomy available to school head teachers and governors can represent an obstacle to service provision - and inter-professional collaboration - in a climate where, in many schools, there is still considerable ambivalence about discussing 'sex' openly. In conclusion, we identify areas worthy of further research and development, in order to address some obstacles to sexual health service and SRE provision in schools

The Experiences of First-Time Fathers in Perinatal Services: Present but Invisible

Fathers in the UK are becoming more involved in the care of their infants and children. A constructivist grounded theory approach was adopted to explore men’s transition to fatherhood. This paper reports on one of the sub-categories derived from the data. First-time fathers with a child under two were recruited predominantly via social media. Audio-recorded semi-structured interviews were undertaken with an opening question asking men to tell their story of becoming a father. Interviews were transcribed and analysed using constructivist grounded theory methods. This paper reports one core aspect of the research findings which has particular relevance for healthcare professionals. The men in this study were highly appreciative of the care their partner and baby received but consistently reported a lack of father-specific support throughout their journey to fatherhood. This ranged from generally poor communication with healthcare professionals to being ignored and side-lined in maternity settings where they continued to be treated as visitors before, during and after the birth of their baby. Despite similar findings being reported over the last 30 to 40 years and policy directives emphasising the importance of working with fathers, change within healthcare services remains slow. Currently, fathers’ needs are not being adequately met by perinatal services